中国血液净化

›› 2008, Vol. 7 ›› Issue (1): 16-18.

• 论著 • 上一篇    下一篇

大剂量利尿剂减少血液透析患者心血管并发症临床研究

邹贵勉1　黄江燕1 车文体1　蒋玉红1　眭维国1 邹和群2

  

  1. 解放军第181医院全军肾移植与透析治疗中心
  • 收稿日期:2007-09-24 修回日期:1900-01-01 出版日期:2008-01-12 发布日期:2008-01-12

Application of large dose of diuretics in ESRD patients on maintenance hemodialysis

ZOU Gui-mian, HANG Jiang-yan, CHE Wen-ti, JIANG Yu-hong, SUI Wei-guo, ZOU He-qun

  

  1. Center of Kidney Transplantation and Dialysis of PLA. No. 181 Hospital of PLA
  • Received:2007-09-24 Revised:1900-01-01 Online:2008-01-12 Published:2008-01-12

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摘要： 目的 为探索大剂量利尿剂对终末期肾病(ESRD)维持性血液透析患者心血管并发症防治的效果。方法 将解放军第181医院54例尿量在200～500ml的新进入维持性血液透析的ESRD患者随机分成2组，研究组(27例，使用大剂量利尿剂，呋塞米片80～160mg/d或布美他尼片3～4mg/d，透析后第二天始分2次口服，透析日停用)和对照组(27例，不用利尿剂)，研究开始前两组患者基本情况：年龄、原发病、平均尿量、血压、心胸比等差异无显著性，平均透析间期和透析时间差异无显著性，治疗高血压、限制水盐、控制贫血等慢性肾衰竭一体化治疗措施两组相同，观察治疗期为12个月，终点事件为死亡或充血性心力衰竭，并比较两组平均尿量、平均透析超滤量、血压控制情况、心胸比、心力衰竭发生情况等指标。结果 研究结束时，与研究开始前相比，研究组尿量的进一步减少明显少于对照组(P =0.045)；与对照组相比，研究组患者达到干体重所需平均超滤量减少(P =0.006)，高血压减轻(平均动脉压较低，P =0.02)，心胸比减小(P =0.04)，心力衰竭发生率显著降低(P=0.008)，高钾血症发生率显著降低。研究组无患者死亡，对照组死亡3例(3/27)。结论 ESRD维持性透析患者使用大剂量利尿剂对控制水钠潴留有一定作用，使透析患者血压更容易控制，平均所需超滤量减少，内环境相对稳定，并因此减少血液透析心血管并发症，提示该疗法对减少维持性血液透析患者心血管并发症是一种经济而有效的治疗措施。

关键词: 维持性血液透析, 大剂量利尿剂, 心血管并发症

Abstract:

objective To explore the efficacy of large dose of diuretics in preventing cardiovascular complications in ESRD patients on maintenance hemodialysis. Methods fifty-four ESRD patients, initiating maintenance hemodialysis, with urine volume between 200～500 ml/d were randomly divided into study group and control group. The patients in study group were administered with furosemide 80～160 mg/d or bumetanide 3～4mg/d, excepting dialysis day, and the patients in control group were not administered any diuretics. Beside diuretics, all patients in the two groups received the same integrated treatment schedule including anti-hypertension, controlling water and salt input, treating anemia, etc. The baseline data such as age, primary diseases, pre-study daily urine volume, pre-study blood pressure and pre-study heart-to-chest ratios were not significantly different between tow groups. The observation duration was 12 months and the end-point events were death and congestive heart failure. The mean daily urine volume, mean ultrafiltration volume in each dialysis session, blood pressure, heart-to-chest ratio and the episodes of congestive heart failure were compared between two groups by the end of the study. Results At the end of the study, compared to controls, the further reduction of daily urine volume in study group was significantly less, mean artery pressure and heart-to-chest ratios significantly lower, the incidence of congestive heart failure significantly lower, the reduction of residual renal function retarded, and the incidence of hyperkalemia significantly reduced. No case in study group while 3 controls died. Conclusion It is indicated that the usage of large dose diuretics was profitable in preventing water-sodium retention in ESRD patients on maintenance hemodialysis, better controlling blood pressure, reducing ultrafiltrate needed by the patients, which is effective in reducing the incidence of the cardiovascular complications of the hemodialysis patients. It is suggested that large dose of diuretics might be an economic and effective therapy for ESRD patients on maintenance hemodiapysis patients.

Key words: Large dosage of diuretics, Cardiovascular complications

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